Basic Information
| Provider Information | |||||||||
| NPI: | 1760922314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUH | ||||||||
| FirstName: | CONNIE | ||||||||
| MiddleName: | YOUNG | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 DESCANSO DR | ||||||||
| Address2: | |||||||||
| City: | LA CANADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910113138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186339081 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 E FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265772261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2017 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 16955 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.